Etiology and management of the hypertensive phase in glaucoma drainage-device surgery.

Insertion of glaucoma drainage devices has become a mainstay in the surgical management of multiple forms of glaucoma, and the indications for this procedure continue to expand. A unique clinical challenge in the postoperative care of these devices is the hypertensive phase, a period of postoperative intraocular pressure elevation in the first three months after surgery. We discuss the influence of a variety of factors on the development of the hypertensive phase after glaucoma drainage implantation, including type of device, device material, and device surface area. Furthermore, several intraoperative and postoperative interventions are investigated as attempts to mitigate this phenomenon. Included among these are the use of antimetabolites, collagen matrix, and a variety of approaches to postoperative inflammation and intraocular pressure control. We provide an overview of our current knowledge of the etiology and management of the hypertensive phase.

Suture Stenting of a Tube Fenestration for Early Intraocular Pressure Control After Baerveldt Glaucoma Implant Surgery.

PURPOSE: To evaluate the efficacy and safety of a tube fenestration stented with a 10-0 polyglactin suture for controlling early postoperative intraocular pressure (IOP) after Baerveldt glaucoma implant (BGI) surgery. METHODS: The medical records of 110 patients (119 eyes) who underwent BGI surgery with a tube fenestration stented with a 10-0 polyglactin suture anterior to an occlusive tube ligature were retrospectively reviewed. Main outcome measures included IOP and number of glaucoma medications at postoperative day 1, week 1, and weeks 2 to 3 as well as complications occurring before ligature release. RESULTS: Mean±SD preoperative IOP was 30.9±9.3 mm Hg using an average of 3.8±1.1 glaucoma medications. A statistically significant reduction in IOP and glaucoma medications was observed at all timepoints during the first 3 postoperative weeks compared with baseline (P<0.001). Mean IOP on postoperative day 1, week 1, and weeks 2 to 3 was 18.4±12.2 mm Hg on no medication, 15.9±9.4 mm Hg on 1.0±1.3 medications, and 16.7±8.2 mm Hg on 1.2±1.5 medications, respectively. In total, 44 eyes (37%) achieved IOP control without glaucoma medication during period of tube occlusion. CONCLUSIONS: The use of a single, monofilament 10-0 polyglactin suture to stent a fenestration proximal to the occlusive ligature of a BGI tube is effective in controlling IOP in the early postoperative period. Hypotony-related complications were infrequent and resolved in all cases with in-office interventions.

Cornea donors who have had prior refractive surgery: data from the Eye Bank Association of America.

PURPOSE OF REVIEW: Millions of Americans have undergone refractive surgeries, including radial keratotomy, photorefractive keratectomy, and laser-assisted in situ keratomileusis. Eye Bank Association of America medical standards do not permit corneas from patients who have undergone refractive procedures to be used in penetrating keratoplasty, anterior lamellar keratoplasty, or tectonic grafting procedures. Such corneas, can, however, be used for endothelial corneal transplantation. The objective of this article is to provide an update on current trends for the screening and usage of corneas that have undergone refractive surgery. RECENT FINDINGS: Several case reports have highlighted the difficulty in using postrefractive surgery corneas in penetrating keratoplasty. However, tissue with anterior stromal flaws, including a history of refractive surgery, has been used in endothelial keratoplasty with equivalent outcomes in topography, endothelial cell count, and visual acuity. Many modalities for proper identification of postmortem donor corneas that have undergone refractive surgery have been studied. SUMMARY: Corneas with a history of refractive surgery have found use in endothelial keratoplasty. Multiple objective methods of tissue identification have been investigated to avoid the use of these corneas in penetrating or anterior keratoplasty surgeries.

Case-Control Study of Herpes Simplex Eye Disease: Bronx Epidemiology of Human Immunodeficiency Virus Eye Studies.

PURPOSE: To determine whether human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), diabetes mellitus, and atopic disease are associated with herpes simplex virus (HSV) eye disease and to examine the characteristics of patients with HIV infection and HSV eye disease. DESIGN: Retrospective case-control study. METHODS: A hospital-based control group was matched to outpatient visits from June 1, 2010, through May 31, 2014, at Montefiore Medical Center (Bronx, NY). Inclusion criteria were a diagnosis of HSV eye disease during the study period and residency in the Bronx. Associations evaluated included age, sex, HIV/AIDS, diabetes mellitus, and atopic disease. RESULTS: HSV eye disease was confirmed in 70 patients, who were compared with 280 controls. Patients with ocular HSV had a greater prevalence of HIV/AIDS compared with controls (8.6% and 2.9%, respectively). Using multivariate analysis to control for age and sex, atopic dermatitis [odds ratio (OR) 3.08, 95% confidence interval (CI), 0.84-11.20] and diabetes with chronic complications (OR 2.25, 95% CI, 0.91-5.61) approached significance, whereas HIV/AIDS (OR 3.37, 95% CI, 1.09-10.40), an age less than 45 years (OR 2.89, 95% CI, 1.54-5.41), and male sex (OR 1.85, 95% CI, 1.07-3.18) were significant. In patients with HIV infection and HSV eye disease, 3 of 6 (50%) had confirmed AIDS at the time of ocular HSV diagnosis. CONCLUSIONS: Patients with HIV infection have more than a 3-fold increased risk of developing ocular HSV.

Incidence of use of acid suppression medications in infants with oral clefting.

OBJECTIVE: Less than 1% of the general pediatric population needs pharmacologic therapy for reflux symptoms; yet, the co-existence of gastroesophageal reflux disease (GERD) with oral clefting remains unclear. The purpose of this retrospective study was to appreciate the difference in the incidence of anti-GERD pharmacotherapy in a sample population of infants with oral clefting compared to the general pediatric population. MATERIALS AND METHODS: One hundred ninety-six consecutive patients diagnosed with cleft lip only, cleft lip and palate, and isolated cleft palate were analyzed through clinical record review. Demographic and clinical information including but not limited to the type of oral cleft present at birth, reported signs and symptoms of GERD, and anti-GERD medications used were compiled for all subjects. Collected data were analyzed using descriptive statistics. RESULTS: Sixty-four (33%) of 196 infants with oral clefts had documented signs and symptoms of GERD. Nine percent (18 of 196) of the subjects received anti-GERD medications. The infant subgroup with treated GERD consisted of 11 out of 62 (18%) patients with isolated cleft palate, 5 of 112 (4.5%) with cleft lip and palate, and 2 of 17 (11%) with cleft lip only. CONCLUSIONS: The incidence of anti-GERD pharmacologic therapy among infants with oral clefts (9%) is significantly higher than among the general pediatric population (<1%). Furthermore, palatal clefts impart a greater risk of GERD symptoms than clefts of the alveolus, lip, or nose. In order to minimize the long-term consequences of GERD, a standardized interdisciplinary clinical protocol is necessary for evaluating infants with oral clefts.